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Human papillomavirus vaccine (Gardasil 9°): useful in young men too

The 9-valent human papillomavirus vaccine (Gardasil 9°) probably has a positive harm-benefit balance in the men who are  the most at risk of developing papillomavirus-related cancer.

Some human papillomaviruses (HPVs) can be transmitted sexually. These infections causing are usually asymptomatic and, in most cases, resolve without treatment. These infections sometimes cause genital warts, which are small, benign lesions. They can also cause precancerous lesions, particularly in immunosuppressed patients.

As of early 2021, after about 15 years in use, it appears highly likely that HPV vaccines effectively prevent cervical cancer. The main HPV-related cancer risk for men is anal cancer in men who have sex with men. In France, HPV vaccination is recommended for men under 27 years of age who have sex with men and for all males aged 11 to 19 years.

Vaccinating men reduces the incidence of precancerous anal lesions and probably anal cancer. A number of countries have chosen to vaccinate men as well as women against HPV, but it is too soon to tell how this has affected HPV transmission and the number of women developing precancerous lesions or cervical cancer.

A risk of Guillain-Barré syndrome associated with HPV vaccination has not been ruled out, and it could affect roughly 1 in every 100 000 to 1 million vaccinees.

As of early 2021, HPV vaccination probably has a positive harm-benefit balance in young men who have sex with men, especially if they are vaccinated before or soon after becoming sexually active. Vaccinating all males aged 11 to 19 years sidesteps the need to ask for  the person’s sexual orientation.

©Prescrire 1 July 2021

Source: "Human papillomavirus vaccine in men. A topic to be addressed early on with all young men" Prescrire International 2021; 30 (228): 190-191. Subscribers only.

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